Preclinical phase
In the first phase, a theoretical basis was established on the basis of relevant literature. The theoretical background of this peer support intervention lies within the social support model [
7,
14]. This model hypothesises that individuals who experience support are likely to have a better quality of life, fewer negative feelings and are thought to take better care of themselves. Three elements appear repeatedly in the descriptions of peer support interventions: emotional, informational, and appraisal support [
7]. Emotional support concerns the possibility of discussing personal difficulties with another person. It is associated with sharing life experiences and involves the exchange of empathy, trust and caring [
15]. Informational support is the exchange of advice, suggestions and information relevant to problem solving [
16]. Appraisal support involves the exchange of information that is useful for self-evaluation purposes: constructive feedback, affirmation and social comparison [
7]. Informational support and appraisal support are often combined into one social support domain [
17].
During peer support interventions patients not only receive informational, appraisal and emotional support, but patients also get the chance to support others. Therefore, peer support can combine the health benefits of both receiving and providing support. Evidence exists that suggests that providing support may result in health benefits comparable to–or even greater than–receiving support [
18]. Individuals who provide social support experience less depression, a heightened sense of self-efficacy and self-esteem, improved quality of life and health behaviours, and decreased mortality risk, even after adjusting for baseline health status and socioeconomic status [
18].
Figure
1 shows two elements of peer support and their hypothesised effects. Our group-based, peer support intervention is expected to lead to a decrease in diabetes-related distress. This decrease may then result in improved health-related quality of life, well-being, and self-management behaviour.